Coronavirus Update #84
Testing, Staffing, & PPE, State Reporting Requirements,
Federal Reporting Requirements and Resources, FEMA PPE Update,
CMS Claims Processing Guidance, Updated CDC Guidance

Here is a Baltimore Sun article on testing/staffing/PPE and a directive from Baltimore County. It is useful to read the article and review the directive together.
In the fight against COVID-19 the fragmented government approach makes work in healthcare much harder and less effective. In the absence of a state testing and staffing plan at this point, local jurisdictions are taking different and varied action on testing, staffing and crisis planning for our sector. 

It is unfortunate that state and local governments publicly report and comment on the lack of testing supplies and capacity or staffing, but then order the sector to conduct testing and to augment staffing. This weekend, I did advise members who reached out to me on developing staged and phased testing plans, first of patients and residents (generally all patients and residents are at increased clinical risk), and based on the availability of testing. I believe the state will have a plan later this week, just my gut and no knowledge.  And I do believe that a state plan and the leadership of Col. Allely and his team will make a huge positive difference. We are committed to helping in his mission.

And we, along with all of our partners, are communicating and advocating on your behalf on these orders.

The general themes we’ve been discussing together, communicating and advocating since February remain more critically important than ever before:

  • File your daily CRISP Report, seven days a week.
  • Focus on providing quality care—continue to train employees on proper PPE use and deployment.
  • Don’t let what you can’t do prevent you from what you can do in providing quality care.
  • Appreciate your team.
  • Be transparent in your communication with residents, patients, families and staff.
  • Operate DRIVEN by your infectious disease protocol.
  • Execute your observation and isolation beds.
  • Work closely with your acute-care hospital partners and home health partners.
  • Stay in contact with local health offices and the Office of Health Care Quality (OHCQ).

Together we will navigate these waters. 
Be well,
And, as a reminder, please see the letters we have sent to
Governor Hogan regarding these issues:
State Reporting Requirements

As you know, the Maryland Department of Health (MDH) recently issued this nursing home reporting notice.

All Maryland nursing homes are required to submit daily reporting information through CRISP as required by COMAR and Governor and Health Secretary orders and directives, issued during a declared State emergency and healthcare pandemic. Under Maryland Health General Article Sections 19-359 and 19-1401 et. seq., and COMAR through .74, the Maryland Department of Health has the authority to impose a  civil money penalty   (CMP) based upon the existence of a deficiency at a nursing home.    The failure to comply with this directive constitutes a deficient practice.  

OHCQ will be monitoring compliance with this requirement on a daily basis. Please ensure immediate and continued compliance.

Please note that the link in the MDH order does not link to the actual CRISP portal. 

This is the link to the reporting portal:

Should you have any questions, please contact: William (Bill) Hokemeyer, Jr. at 410.596.8205 or at
Federal Reporting Requirements
CMS recently released an interim final rule with comment period which revises § 483.80, establishing explicit reporting requirements for long-term care (LTC) facilities to report information related to COVID-19 cases among facility residents and staff. These reporting requirements are applicable on the effective date of this interim final rule, which is the date of the publication at the Office of the Federal Register.

Materials from CDC NHSN on New COVID-19 Module for Nursing Homes

CDC NHSN has released more materials for nursing homes to prepare for this new reporting requirement, including a guide to using the COVID-19 module . Visit the CDC website to sign up for updates

There will be a webinar training tomorrow for the new LTCF COVID-19 Module. This webinar will be recorded and posted to the LTCF COVID-19 Module webpage with a PDF of the slide presentation. 

COVID-19 Module Overview for Long-term Care Facilities 
Tuesday May 5, 2020 
3:00 – 4:30 PM Eastern Time

Learn how to join these webinars on the CDC NHSN website . If you have any questions, please email CDC at and include LTCF COVID-19 in the subject line.
Update on FEMA PPE Supply to Nursing Homes

FEMA will coordinate two shipments totaling a 14-day supply of personal protective equipment (PPE) to nursing homes across the nation.

By the beginning of July, each center will receive two separate packages containing a seven-day supply of eye protection, surgical masks, gowns, and gloves. Each center will receive an allotment of all four items based on the staff size of the facility.

The Level 1 medical gowns included in the shipments are intended for use in basic care settings for minimal risk situations. The gowns are durable and can be washed 30 to 50 times.

Due to the large number of nursing homes, centers are not likely to receive notification prior to their shipment arriving. However, as possible, FEMA will provide notification to a state prior to shipments arriving at their Medicaid/Medicare-certified facilities.

The first shipments will begin this week and will continue throughout May. Initial shipments will focus on metropolitan-area priority sites, such as New York City, Northern New Jersey, Boston, Chicago and Washington D.C. The second shipment of supplies will start at the beginning of June. We will continue to share more information as it becomes available.

CMS Issues Claims Processing Guidance Related to New COVID-19 ICD-10 Code 

Our partners at AHCA reported to CMS an apparent glitch with implementing the U07.1 - 2019-nCoV acute respiratory disease ICD-10 CM code when the five-day assessment window overlaps March into April dates of service. 

For example, when the MDS assessment reference date (ARD) is in April [4/1/20], but the date of service (DOS) is in March [3/25-3/31]. This is creating a problem given the U07.1 code is valid as primary in the MDS grouper April 1 but not on the UB-04 for DOS prior to April 1. Specifically, this is creating a primary diagnosis conflict whereby providers cannot match the primary diagnosis on the UB-04 in form locator 67 with the primary reason for skilled care in item I0020B of the MDS. 

CMS has provided the following standardized guidance to the MACs:
“Based on the following guidance from the CMS PDPM FAQs question 1.8 is to tell providers with a 5-Day PPS MDS with an April 2020 ARD, but a lookback period that extends into March 2020 that, when applicable, they can use the COVID 19 ICD-10 code U07.1 in MDS item I0020B to obtain the appropriate PDPM case-mix classification, but that the claim associated with March DOS must contain a different ICD-10 code that applies to the beneficiary and that was valid in March.
“We understand that this is a one-time event that only impacts a relatively small number of admissions related to COVID-19 that spanned the March-April implementation of the new U07.1 diagnosis code. The claim will need to contain a different diagnosis other than U07.1 but the assessment may contain U07.1 code in these instances .”
Updated CDC Guidance Released on Return to Work and Clinical Care

The Centers for Disease Control and Prevention (CDC) released two updated guidances on April 30, 2020, around criteria for returning to work for healthcare personnel (HCP) with confirmed or suspected COVID-19 and the discontinuation of transmission-based precautions and disposition of patients with COVID-19.

1. Updated Criteria for Return to Work for HCP with Confirmed or Suspected COVID-19   - Decisions about return to work for HCP with confirmed or suspected COVID-19 should be made in the context of local circumstances. This updated guidance includes the following: 

  • Changed the name of the ‘non-test-based strategy’ to the ‘symptom-based strategy’ for those with symptoms and the ‘time-based strategy’ for those without symptoms
  • Updated these to extend the duration of exclusion from work to at least 10 days since symptoms first appeared. 

The CDC specifically notes that after returning to work, HCP should:

  • Wear a facemask for source control at all times while in the healthcare facility until all symptoms are completely resolved or at baseline. After this time period, these HCP should revert to their facility policy regarding universal source control during the pandemic. 

  • Self-monitor for symptoms, and seek re-evaluation from occupational health if respiratory symptoms recur or worsen.

CDC also has information focused around strategies to mitigate healthcare personnel staffing shortages you might be interested in reviewing. 

  • Changed the name of the ‘non-test-based strategy’ to the ‘symptom-based strategy’ for those with symptoms and the ‘time-based strategy’ for those without symptoms, and updated these to extend the duration of Transmission-Based Precautions to at least 10 days since symptoms first appeared. 

  • Added criteria for discontinuing Transmission-Based Precautions for patients who have laboratory-confirmed COVID-19 but have not had any symptoms of COVID-19.

According to the CDC, if a patient is discharged to a nursing home or other long-term care facility (e.g., assisted living community), AND transmission-based precautions:

  • are still required, they should go to a facility with an ability to adhere to infection prevention and control recommendations for the care of COVID-19 patients. Preferably, the patient would be placed in a location designated to care for COVID-19 residents.

  • have been discontinued, but the patient has persistent symptoms from COVID-19 (e.g., persistent cough), they should be placed in a single room, be restricted to their room to the extent possible, and wear a facemask (if tolerated) during care activities until all symptoms are completely resolved or at baseline.

  • have been discontinued and the patient’s symptoms have resolved, they do not require further restrictions, based upon their history of COVID-19.
Reminder: Eligibility Action Transmittal

The Maryland Department of Health (MDH) recently shared this Action Transmittal that directs DSS caseworkers to determine eligibility based on information in the application and not require additional verification.

Please direct policy questions to the Maryland Department of Health, Office of Eligibility Services at  or call 410-767-1463 or 1-800-492-5231 (select option 2 and request extension 1563).
CMS COVID-19 Stakeholder Engagement Calls – Week of 5/04/20

CMS hosts varied recurring stakeholder engagement sessions to share information related to the agency’s response to COVID-19. These sessions are open to members of the healthcare community and are intended to provide updates, share best practices among peers, and offer attendees an opportunity to ask questions of CMS and other subject matter experts.

  • CMS COVID-19 Office Hours Calls (Tuesdays and Thursdays at 5:00 – 6:00 PM Eastern

  • Lessons from the Front Lines: COVID-19 (Fridays at 12:30 – 2:00 PM Eastern)

  • Weekly COVID-19 Care Site-Specific Calls:

  • Home Health and Hospice (Tuesdays at 3:00 PM Eastern)
  • Nursing Homes (Wednesdays at 4:30 PM Eastern)
  • Dialysis Organizations (Wednesdays at 5:30 PM Eastern)
  • Nurses (Thursdays at 3:00 PM Eastern)
May is Older Americans Month and Mental Health Awareness Month

Below are upcoming opportunities and resources:

  • The National Coalition on Mental Health and Aging is co-sponsoring a virtual event with the Substance Abuse and Mental Health Services Administration, the Administration for Community Living and the Veterans Health Administration as part of NATIONAL OLDER ADULT MENTAL HEALTH AWARENESS DAY 2020 on May 7th at 1pm. The title is “Combating Social Isolation for Seniors during the COVID-19 Pandemic” and attached is the announcement. For those who cannot attend for the live broadcast the webinar will be recorded and posted to the NCMHA, when available. Recordings of all past NCMHA webinars can be found here:

  • As part of the Older Americans Month observation in May, the Coalition to End Social Isolation and Loneliness and the National Coalition on Mental Health and Aging are co-sponsoring a special webinar “Social Isolation and Loneliness Among Older Americans During COVID-19: Evidence, Policy, and Advocacy”. This 90-minute event will provide an in-depth examination of the: scope of the problem, biological impacts of social isolation and loneliness, interventions and promising practices, and policy considerations. Register here:

  • The Administration for Community Living developed a COVID 19 resource titled “What Do Older Adults and People with Disabilities Need to Know?” which is regularly updated and very helpful for older adults and their care partners. Visit

  • The Older Adult Behavioral Health Specialists (OABHS) in Maryland are able to be flexible and helpful with local COVID 19 behavioral health concerns / efforts. Attached is an updated OABHPS brochure for your information. If you are thinking about establishing a local response to older adult behavioral health needs, call on your local OABHS for collaboration.

  • Two weekly virtual 12 step meetings of Alcoholics Anonymous, “Better with Age”, have been established to support older Marylanders during this pandemic and beyond. More information on these meetings and others can be found through the Baltimore Intergroup Council of Alcoholics Anonymous website
Healthcare Heroes
Collington Lifecare Community: "Inspiration comes in many forms. As we trudge through the uncertainty of COVID-19, my respect and admiration of my team mates has grown by leaps and bounds. I am inspired EVERY day by witnessing first hand our Healthcare Heroes. Whether it be our Health Center medical team caring for our most vulnerable or our culinary delivering over 200 meals to the independent living resident homes, I am fortunate to see the passion and commitment firsthand for all of our team members. Our heroes wear masks not capes!"
Who are your healthcare heroes?

There are so many amazing stories of dedication, sacrifice, and compassion by long term care professionals who are going above and beyond to ensure the safety, health, and happiness of residents during this unprecedented time. These individuals are saving lives; they are heroes.

We want to hear your stories! Please email     to share a current story and picture of members of your team who are going above beyond to provide quality care during this unprecedented time. 
Did you miss HFAM's previous alerts?

Visit our website to view all previous HFAM alerts, as well as guidance
from our federal and state partners.
Thank you.

We cannot thank you enough for the dedication and diligence in doing all that you can for the residents in your communities. HFAM continues to monitor the COVID-19 pandemic with our state and national partners and will do all we can to support you during this time.